Crit Care Resusc
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Estimation of stroke volume variation (e.g. systolic blood pressure and systolic area variability) and central extracellular compartment volume (e.g. initial volume of distribution of glucose, IVDG) may be useful in guiding fluid therapy in mechanically ventilated patients. The reliability of systolic blood pressure (SBP) variability has been well validated, but little is known about systolic area (SA) variability or IVDG. Our aim was to investigate SBP and SA variability and IVDG as predictors of preload responsive hypovolaemia in post-cardiac surgery patients. ⋯ Our results indicate that neither IVDG, nor SBP and SA variability are predictive of preload responsive hypotension in post-cardiac surgery patients. Spectral analysis of SBP and SA may be more sensitive at assessing preload responsiveness in this patient group than traditional maximum-minimum measures.
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To review the human nutrition in the critically ill patient in a three-part presentation. ⋯ Nutritional requirements for the critically ill patient should be delivered enterally in patients who have a normally functioning gastrointestinal system. A standard formulation is usually prescribed and instilled into the stomach using a fine bore tube. If gastric emptying is delayed prokinetic agents are tried before a transpyloric tube or enterostomy tube feeding is considered. Diarrhoea caused by enteral pathogens may require specific treatment. If pathogens are excluded then fibre and probiotics may be considered. Motility reducing agents (e.g. opiates) may cause abdominal bloating.
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To examine difficulties in sedation management in the critically ill patient and explore how a semi automated sedation controller can improve agitation control. To present recent work on measurements of agitation, dynamic systems modelling and control of patient agitation response. ⋯ A simple computerised interface with an algorithm that continually reduces the infusion rate in the absence of agitation has successfully been introduced into clinical practice. Nursing staff reported high levels of satisfaction with this device and it has enabled detailed data on patterns of sedation administration to be extracted for analysis. This data has been used to validate a model of the fundamental agitation-sedation dynamics.
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We believed that intercostal catheters were often inserted too far into the thoracic cavity in neonatal patients. The aim of this study was to determine the average distance from the catheter tip to the midline, of intercostal catheters inserted in our neonatal unit and the incidence of catheters that were inserted too far into the thoracic cavity. ⋯ Fifty four percent of the intercostal catheters inserted in our unit were inserted too far. As the distance markings on the Argyle intercostal catheters are marked from the last side-hole rather than from the tip of the catheter, Argyle intercostal catheters may be inadvertently inserted two centimetres further than they should be.
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To review the management of the difficult airway in the intensive care unit patient. ⋯ The principles of difficult airway management, including a back-up plan and calling for assistance early, hold true in the intensive care setting as much as in any other clinical setting. It is vital that clinicians develop their own difficult airway algorithm based on their training and experience.